When you're on the road to wellness from depression, it's not uncommon for your depression symptoms to flare up again. Learn some strategies for coping when you feel depressed.

Much of the time, Diane Carbo deals pretty well with her depression, but some days aren't as good as others. For Carbo, a nurse in North Wales, Pa., depression symptoms return from time to time, especially during the winter when the weather turns cold and dreary. "I find myself struggling with sadness, tearfulness, and a lack of interest in doing things on those bad days," Carbo says.

Carbo's bad days are sometimes referred to as setbacks — common hurdles in depression treatment that can slow a patient's progress, says David Blackburn, PhD, a psychologist at Scott & White Hospital in Temple, Texas. Blackburn says he periodically gives his patients a list of depression symptoms, like excessive sleeping and crying spells, and asks them to check off the ones that they are experiencing.

"If they're going along and the scores get lower, they're going in the correct direction," Blackburn says. "However, something may happen and their scores may start going back up. That's a setback."

Setbacks can cause a vicious cycle, Blackburn says, because they can often worsen a person's depression symptoms. "They might get even more discouraged than they already are," Blackburn explains. "They think, 'Oh, I was doing so well, what happened?'"

Help for Setbacks

There are ways to overcome setbacks and move away from depression and toward wellness again. Try some of these strategies when you feel yourself slipping back into a depressed mood:

Use coping techniques. When Blackburn's patients experience a setback, he tries to remind them of the strategies they learned earlier in the course of their depression treatment, like avoiding thoughts that tend toward the absolute — for example, telling yourself "I can never do anything right." Blackburn also says that people with depression should try to take stressful events in stride and stop fixating on situations they have no influence over. "It's important to recognize that you, as an individual, cannot control a situation or people in it," Blackburn says. "The only thing you can control is how you respond."

Improve dietary and exercise habits. If you take care of your body, you'll feel better, both mentally and physically. Even a small amount of physical activity can improve a person's outlook. A recent study found that sedentary behaviors, like watching TV and using the computer, are associated with an increased risk of depression. The hardest part, Blackburn says, is not the actual exercise, but becoming motivated enough to get started. "I go by the Nike commercial. Just do it," Blackburn says. "You'll feel better afterward."

Carbo agrees, and says her exercise routine can help lift her out of a bad mood. "I force myself to get up and go out and walk, even if it is at the mall," she says. As for diet, the U.S. Department of Health and Human Services recommends that adults eat at least two cups of fruit and two and a half cups of vegetables per day, as well as plenty of whole grains and low-fat dairy products, like milk. Blackburn says that patients should also take care to avoid "emotional eating" — taking in excessive amounts of unhealthy foods as a way of coping with stress. "It doesn't solve the problem — it's just a temporary fix," Blackburn says.

Ask about adjusting your medication. If you're on an antidepressant or other medicine for depression, sometimes setbacks can occur if the medication becomes less effective, Blackburn says. Sometimes, a simple switch is all that is needed to move forward. "The advantage is there are a number of medications that are available," Blackburn says. "But it can be trial and error. Each person may react differently to different medications. You have to be patient, in other words." If you feel that a medication problem may be causing your setback, consult the physician who originally prescribed it to you for suggestions.

Consider psychotherapy. If you've been managing your depression with medication alone, you may find that adding psychotherapy to your depression treatment regimen is beneficial. "Medication can improve your mood to the point where psychotherapy can be more successful," Blackburn says. Therapy practitioners include psychologists, licensed professional counselors, marriage and family therapists, and psychiatrists who, as medical doctors, can also prescribe and manage your depression medications.

With a little patience and the understanding that depression symptoms can return from time to time, you can cope successfully with periodic episodes of depression.

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